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1.
Michael M. Kheir Mary Ziemba-Davis Julian E. Dilley Mark J. Hood R. Michael Meneghini 《The Journal of arthroplasty》2018,33(11):3455-3459
Background
This study examined whether a modern total knee arthroplasty (TKA) protocol without a tourniquet results in less patient-reported pain and in-hospital opioid consumption compared to TKA with a tourniquet.Methods
A retrospective study of 203 primary unilateral cemented TKAs consecutively performed with or without tourniquet was performed. Identical perioperative pain and blood loss protocols were used in all cases. In tourniquetless TKAs, the tourniquet was not inflated at any time, and sterile CO2 gas compression maximized cement interdigitation.Results
After exclusions for scientific confounds, 184 TKAs (93 with tourniquet; 91 tourniquetless) were analyzed. Controlling for multiple covariates, females with a tourniquet reported significantly more pain (P = .002) and opioid consumption (P < .001) the first 24 hours after surgery compared to females without a tourniquet. There were no differences in pain (P = .192) or amount of opioids consumed (P = .203) among males with and without a tourniquet. Tourniquet use resulted in a significant reduction in blood loss for both females (P ≤ .040) and males (P ≤ .020), although the total blood savings of approximately 200 mL is of unknown clinical significance.Conclusion
Avoiding tourniquet use during TKA for females may be a relatively risk-free adjunct to minimize opioid consumption during hospitalization. Further study is warranted to elucidate the factors accounting for different outcomes in females and males. 相似文献2.
Rhodri L. Williams Wayne N. Ayre Wasim S. Khan Amisha Mehta Rhidian Morgan-Jones 《The Journal of arthroplasty》2017,32(3):953-957
Background
Thorough debridement is mandatory in revision for infected total knee arthroplasties (TKA). We investigated a novel adjuvant chemical debridement strategy using acetic acid (AA) that seeks to create a hostile environment for microorganisms. We report the first orthopedic in vivo series using an AA soak in infected TKAs. We also investigated the in vitro efficacy of AA against bacteria isolated from these knees.Methods
Twenty-three patients with infected TKA were treated with a standard debridement protocol and chemical debridement with a 20-minute AA soak. In parallel, bacteria from infected TKAs were cultured for in vitro susceptibility testing with AA solutions of different concentrations to understand its potential mechanism of action.Results
Intraoperatively, there were no physiological responses during the AA soak or on release of the tourniquet. Postoperatively, there was no increase in analgesic requirements or wound or soft-tissue complications. Clinical follow-up continued for 24 months to monitor recurrent infection. In vitro, zones of inhibition were formed on less than 40% of the organisms, demonstrating that AA was not directly bactericidal against the majority of the isolates. However, when cultured in a bacterial suspension, AA completely inhibited the growth of the isolates at concentrations as low as 0.19% vol/vol.Conclusion
This study has shown that the use of 3% AA soak, as part of a debridement protocol is safe in patients. While the exact mechanism of action is yet to be determined, AA concentrations as low as 0.19% vol/vol in vitro are sufficient to completely inhibit bacterial growth. 相似文献3.
Venkat Boddapati Michael C. Fu David J. Mayman Edwin P. Su Peter K. Sculco Alexander S. McLawhorn 《The Journal of arthroplasty》2018,33(2):521-526
Background
Periprosthetic joint infection (PJI) after primary total knee arthroplasty (TKA) is a devastating complication. The short-term morbidity profile of revision TKA performed for PJI relative to non-PJI revisions is poorly characterized. The purpose of this study is to determine 30-day postoperative outcomes after revision TKA for PJI, relative to primary TKA and aseptic revision TKA.Methods
The American College of Surgeons National Surgical Quality Improvement Program from 2005 to 2015 was queried for primary and revision TKA cases. Revision TKA cases were categorized into PJI and non-PJI cohorts. Differences in 30-day outcomes including postoperative complications, readmissions, operative time, and length of stay were compared using bivariate and multivariate analyses.Results
In total, 175,761 TKAs were included in this study, with 162,981 (92.7%) primary TKAs and 12,780 (7.3%) revision TKAs, of which 2196 (17.2%) revisions were performed for PJI. When compared to aseptic revision TKA, multivariate analysis demonstrated that PJI revisions had a significantly higher risk of major early postoperative complications including death (adjusted odds ratio [OR] 3.25) and sepsis (OR 8.73). In addition, nonhome discharge (OR 1.75), readmissions (OR 1.67), and length of stay (+2.1 days) were all greater relative to non-PJI revisions.Conclusion
Utilizing a large, prospectively collected, national database, we found that revision TKA for PJI has a greater risk of short-term morbidity and mortality and requires a higher utilization of healthcare resources. These results have implications for patient counseling and alternative payment models that may eventually include revision TKA. 相似文献4.
Christian Skovgaard Nielsen Kirill Gromov Øivind Jans Anders Troelsen Henrik Husted 《The Journal of arthroplasty》2017,32(1):177-182
Background
Postoperative anemia is frequent after revision of total knee arthroplasty (TKA) with reported transfusion rates up to 83%. Despite increased efforts of reducing blood loss and enhancing fast recovery within the fast-track setup, a considerable transfusion rate is still evident. The aim of this study was therefore to evaluate the effect of a bipolar sealer on blood loss and transfusion in revision TKA.Methods
In this single-center prospective cohort study with retrospective controls, 51 patients were enrolled in a fast-track setup for revision TKA without the use of a tourniquet. Twenty-five prospectively enrolled patients received treatment with both a bipolar sealer and electrocautery, whereas 26 patients had received treatment with a conventional electrocautery only in the retrospective group.Results
No significant differences were found neither for calculated blood loss, with 1397 (standard deviation, ± 452) mL in the bipolar sealer group vs 1452 (SD, ± 530) mL in the control group (P = .66), nor for blood transfusion rates of 53% and 46% (P = .89), respectively. Four controls were readmitted within 90 days follow-up.Conclusion
The use of a bipolar sealer in a TKA revision setting without the use of a tourniquet did not reduce blood loss or blood transfusion rates. 相似文献5.
Background
This study aimed to compare the efficacy of intravenous administration of tranexamic acid for reducing blood loss in total knee arthroplasty at different dosage time.Methods
From February 2013 to December 2015, a total of 180 patients (47 in male and 133 in female) who were planned to undergo total knee arthroplasty in our trauma center were recorded. Based on dosage time of tranexamic acid administration, participants were divided into groups A, B, C, and D randomly. In groups A, B, and C, tranexamic acid (30 mg/kg) was infused intravenously 15 minutes before or after tourniquet inflation or on tourniquet deflation respectively, tranexamic acid was not applied in group D. Total blood loss (intraoperative and postoperative blood loss), blood transfusion rate and volume, hemoglobin level, and incidence of deep vein thrombosis were recorded and analyzed.Results
Compared with groups B, C, and D, there were significant reduction of blood loss, hemoglobin, and blood transfusion rate in group A (P < .05). Besides, there was no significant difference between groups B and C with superior efficacy than group D.Conclusion
Intravenous administration of tranexamic acid before tourniquet inflation was superior in terms of hemoglobin reduction, reducing blood loss and blood transfusion rate. 相似文献6.
Ville Turppo Reijo Sund Joonas Sirola Heikki Kröger Jukka Huopio 《The Journal of arthroplasty》2018,33(12):3649-3654
Background
There are no actual validation studies of the Finnish Arthroplasty Register (FAR), and only a few studies about the accuracy of self-reported hip and knee arthroplasty exist. Therefore, we examine how reliably total hip (THA) and knee (TKA) arthroplasties can be identified from multiple data sources, including self-reports, the hospital discharge register, the arthroplasty register, and medical records.Methods
Data from the FAR and from the Finnish Hospital Discharge Register (FHDR) during the years 1980-2010 were cross-checked to identify all THA and TKA events for the Kuopio Osteoporosis Risk Factor and Prevention Study cohort (n = 14,220). Unclear events were further checked from the medical records. After establishing a gold standard, by referring to confirmed THAs and TKAs, we examined the validity of self-reports in identifying the prevalent population with THA/TKA and in identifying incident THA/TKA.Results
Completeness of 2820 total arthroplasty events was 96.1% in FAR and 98.3% in FHDR. The self-reports had 95.1% sensitivity and 92.9% positive predictive value (PPV) to identify population with THA and for TKA sensitivity was 94.6% and PPV 95.2%. Self-reports’ sensitivity of finding the actual surgery events was 65.3% and PPV 85.4% for THA and for TKA sensitivity was 62.9% and PPV 83.4%.Conclusion
The best way to identify THAs and TKAs in Finland is to combine data from the FAR and the FHDR. Self-reports can be considered as suitable to identify the prevalent population with THA/TKA, and they do not work as well to identify the actual surgery events. 相似文献7.
Tom Schmidt-Braekling Andrew D. Pearle David J. Mayman Geoffrey H. Westrich Wenzel Waldstein Friedrich Boettner 《The Journal of arthroplasty》2017,32(3):965-967
Background
Although venous thromboembolism is one of the leading causes of morbidity after knee arthroplasty, little data exist on the risk of deep venous thrombosis (DVT) after unicompartmental knee arthroplasty (UKA).Methods
We prospectively enrolled 112 patients undergoing UKA to determine the incidence of DVT utilizing aspirin 325 mg twice a day (BID) for 4 weeks postoperatively as DVT prophylaxis. The data were compared with a recent randomized controlled trial of patients undergoing total knee arthroplasty utilizing aspirin and Lovenox in conjunction with pneumatic compression devices.Results
One patient (0.9%) had an asymptomatic DVT, and none developed clinical symptoms of either DVT or pulmonary embolus. The incidence of asymptomatic and symptomatic DVT was 0.9% and 0%, respectively.Conclusion
Our data suggest that 325 mg of aspirin BID for 4 weeks results in a very low risk of DVT for patients undergoing UKA. 相似文献8.
Background
Considerable blood loss which requires transfusion is frequently reported after total hip and knee arthroplasties (THA and TKA). The purpose of this study is to review the transfusion rates in contemporary THA and TKA with optimized perioperative protocols including minimized surgical trauma and optimal perioperative patient care.Methods
This retrospective study included 1442 consecutive patients receiving either a primary THA or a TKA from the same high-volume surgeon between January 2008 and December 2015. Demographics and surgical data were collected from patients' journals. Estimated blood loss, decline in hemoglobin, and use of transfusion were registered.Results
One (0.0013%) THA and 3 (0.0044%) TKAs required blood transfusion postoperatively. Average measured bleeding was 253 mL ± 142 and 207 mL ± 169 in THA and TKA, respectively. Average decline in hemoglobin was 23.5 g/L ± 11.4 and 22.9 g/L ± 11.6 for THA and TKA, respectively.Conclusion
In contemporary THA and TKA, perioperative protocols and patient optimization can decrease the rate of blood transfusion to near zero. 相似文献9.
Matthew J. Brown John R. Matthews Mary T. Bayers-Thering Matthew J. Phillips Kenneth A. Krackow 《The Journal of arthroplasty》2017,32(7):2120-2126
Background
A number of postoperative complications of navigated total knee arthroplasty (TKA) have been discussed in the literature, including tracker pin site infection and fracture. In this article, we discuss the low postoperative complication rate in a series of 3100 navigated TKAs and the overall complication rate in a systematic analysis of the literature.Methods
Three thousand one hundred consecutive patients with navigated TKAs from 2001-2016 were retrospectively evaluated for complications specific to navigation. We discuss the 2 cases of postoperative fracture through tracker pin sites that we experienced and compare this systematically with the literature.Results
Postoperatively, our 3100 patient cohort experienced a total of 2 fractures through pin sites for an incidence of 0.065%. One was a distal femoral fracture which was treated surgically, and the other was a proximal tibial fracture treated nonoperatively. Because of our incorporation of the tracker sites within our operative incision, there were no identifiable pin site infections, which others have noted at an incidence of 0.47%. Our 0.065% fracture rate compares favorably with the 0.16% rate of fracture published in the literature.Conclusion
There is an extremely low risk of perioperative complications because of the instrumentation used in navigated TKA when using the Stryker Navigation System and 4.0 mm anchoring pins placed within the surgical incision. 相似文献10.
Monther A. Gharaibeh Gandhi N. Solayar Ian A. Harris Darren B. Chen Samuel J. MacDessi 《The Journal of arthroplasty》2017,32(3):777-782
Background
Accelerometer-based, portable navigation devices have been introduced as a less invasive and simpler technique to perform navigated surgical implantation of knee prostheses. They have been postulated to have better accuracy than conventional instruments in restoration of alignment in total knee arthroplasty.Methods
A total of 190 patients were enrolled in this prospective, randomized controlled trial and underwent total knee arthroplasty using either the KneeAlign or conventional guides. Multiplanar alignment was evaluated with a CT imaging protocol.Results
A total of 86.5% of portable navigation device and 82.2% of conventional group had a postoperative hip–knee angle within 3° of neutral alignment (P = .54). There was no significant difference between the 2 groups for component coronal and sagittal plane alignment. Portable navigation device did not significantly increase the time to perform the surgery.Conclusion
Portable navigation device demonstrates accurate restoration of alignment; however, there was no statistically significant difference when compared with conventional guides. 相似文献11.
Background
Recent literature suggests that the difference in revision risk between unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) can be influenced by surgeon volume and other confounders. We hypothesized that implant selection might decrease the relative risk of revision in an adjusted model.Methods
We selected the best performing (BP) primary UKAs and TKAs performed for osteoarthritis between January 2001 and December 2012 collected through a joint replacement registry. We compared aseptic and all-cause risk of revision using a surgeon-stratified Cox regression model with propensity score adjustment.Results
One thousand fifty-four UKAs were compared with 74,185 TKAs. The rate for all-cause revision was lower for UKAs (2.1%) than for TKAs (2.4%), whereas the rate for aseptic revision was higher for UKAs (2.0%) than TKAs (1.4%). The adjusted risk of aseptic revision was not significantly higher for UKA than TKA (hazard ratio = 2.02 [0.68, 5.96], P = .203) or all-cause revision (hazard ratio = 1.24 [0.52, 2.98], P = .603).Conclusion
When comparing the survivorship of the BP UKAs to the BP TKAs in our registry, the adjusted risk of revision remained higher for UKAs than for TKAs, although the difference did not reach statistical significance. 相似文献12.
Bahattin Tuncali Hakan Boya Zeynep Kayhan Sukru Arac 《Acta orthopaedica et traumatologica turcica》2018,52(4):256-260
Objective
The aim of this study was to compare the limb occlusion pressure (LOP) determination and arterial occlusion pressure (AOP) estimation methods for tourniquet pressure setting in adult patients undergoing knee arthroplasty under combined spinal-epidural anesthesia.Methods
Ninety-three patients were randomized into two groups. Pneumatic tourniquet inflation pressures were adjusted based either on LOP determination or AOP estimation in Group 1 (46 patients, 38 female and 8 male; mean age: 67.71 ± 9.17) and Group 2 (47 patients, 40 female and 7 male; mean age: 70.31 ± 8.27), respectively. Initial and maximal systolic blood pressures, LOP/AOP levels, required time to estimate AOP/determinate LOP and set the cuff pressure, initial and maximal tourniquet pressures and tourniquet time were recorded. The effectiveness of the tourniquet was assessed by the orthopedic surgeons using a Likert scale.Results
Initial and maximal systolic blood pressures, determined LOP, estimated AOP, duration of tourniquet and the performance of the tourniquet were not different between groups. However, the initial (182.44 ± 14.59 mm Hg vs. 200.69 ± 15.55 mm Hg) and maximal tourniquet pressures (186.91 ± 12.91 mm Hg vs. 200.69 ± 15.55 mm Hg) were significantly lower, the time required to estimate AOP and set the tourniquet cuff pressure was significantly less (23.91 ± 4.77 s vs. 178.81 ± 25.46 s) in Group II (p = 0.000). No complications that could be related to the tourniquet were observed during or after surgery.Conclusion
Tourniquet inflation pressure setting based on AOP estimation method provides a bloodless surgical field that is comparable to that of LOP determination method with lower pneumatic inflation pressure and less required time for cuff pressure adjustment in adult patients undergoing total knee arthroplasty under combined spinal epidural anesthesia. 相似文献13.
Paolo Adravanti Andrea Tecame Laura de Girolamo Aldo Ampollini Rocco Papalia 《The Journal of arthroplasty》2018,33(3):696-699
Background
The management of patella in total knee arthroplasty (TKA) is a controversial topic. The elevated risk of patellofemoral complications seems to support those who are not eager to perform such procedure. The aim of this study is to carry out a retrospective assessment of patients who underwent patellar resurfacing during TKA from 2004 to 2009.Methods
From January 1, 2004, to December 31, 2009, 1280 patients underwent TKA with patellar prosthesis implantation. Of them, 861 patients (639 women and 222 men with an average age of 67.7 ± 12.3 years) were available for a telephonic interview consisting of the questions included in the Knee Pain Score (KPS). Patients presenting KPS >36 and those subjected to reoperation were then evaluated clinically and radiologically.Results
Of the 861 patients included in the study, 801 showed a KPS <36. Among the remaining 60 patients, 33 had a KPS >36, while 27 had been reoperated at the target knee. In the former case, a decrease in normal Insall-Salvati index and patellar tilt values (from 1.08 to 1.02 and from 9.3 to 9.1, respectively) and average anatomic axis (from ?2.6° to 1.1°) was found comparing preoperative with last follow-up evaluation. Only in 0.6% of the cases of reintervention, patellofemoral complications were found to be the cause.Conclusion
This study conducted on a large and homogenous group of patients confirms a very low rate of complications related to patella resurfacing during TKA. 相似文献14.
Cameron K. Ledford Brian P. Chalmers Joseph M. Statz Kevin I. Perry Tad M. Mabry Arlen D. Hanssen Matthew P. Abdel 《The Journal of arthroplasty》2017,32(1):101-105
Background
Clinical outcomes remain largely unknown beyond perioperative and short-term follow-up of solid organ transplant (SOT) patients undergoing total knee arthroplasty (TKA).Methods
Patient mortality, implant survivorship, and complications of 96 TKAs (76 patients) after SOT were retrospectively reviewed through an internal joint registry. Mean age at index arthroplasty was 66 years, and mean follow-up was 4 years.Results
Overall mortality rates at 1 year, 2 years, and 5 years from TKA were 2.6%, 7.9%, and 13.2%, respectively, and combined SOT patient survivorship was 92% at 2 years and 82% at 5 years. Implant survivorship free of any component revision or implant removal was 98% at 2 years and 93% at 5 years. There was a high rate of perioperative complications (12.5%), including periprosthetic fractures (5.2%) and deep periprosthetic infection (3.2%).Conclusion
TKA does not appear to have any effect on SOT patient survivorship following the procedure. However, SOT patients may have a higher risk of perioperative complications and a lower implant survivorship than the general population of TKA patients at midterm follow-up. 相似文献15.
Guorui Cao Qiang Huang Bin Xu Zeyu Huang Jinwei Xie Fuxing Pei 《The Journal of arthroplasty》2017,32(11):3390-3395
Background
This study aims at evaluating the effectiveness of a new multimodal nutritional management (MNM) on albumin (ALB) transfusion, the incidence of electrolyte disorders, blood loss, perioperative levels of ALB and electrolyte, length of hospital stay (LOH), and complications in patients following total knee arthroplasty without tourniquet.Methods
A total of 162 patients were randomized to receive either the MNM protocol (n = 81, experimental group) or traditional protocol (n = 81, control group). The primary outcomes were the rate and amount of ALB infusion, LOH, total blood loss, maximum hemoglobin drop, allogeneic transfusion rate, and the incidence of electrolyte disorders. The secondary outcomes were levels of ALB and electrolyte at different time points and the incidence of complications.Results
The rate and amount of ALB transfusion required in MNM group were significantly lower than those in control group (P = .006, P = .021, respectively). LOH was shorter in MNM group (P < .001). Total blood loss and maximum hemoglobin drop were similar. The incidence of kaliopenia and hypocalcemia was lower in MNM group on the first postoperative day (P = .019, P = .028, respectively). Patients in MNM group had higher levels of ALB, sodium, potassium, and calcium than those in control group on the first postoperative day.Conclusion
The MNM protocol can effectively low down the amount of ALB transfusion, the number of patients requiring ALB transfusion, the incidence of electrolyte disorders, and LOH following primary total knee arthroplasty without tourniquet. Patients can obtain a smaller decline in ALB, sodium, potassium, and calcium. 相似文献16.
Umile G. Longo Mauro Ciuffreda Nicholas Mannering Valerio D&#x;Andrea Matteo Cimmino Vincenzo Denaro 《The Journal of arthroplasty》2018,33(2):620-632
Background
Patellar resurfacing in total knee arthroplasty remains controversial. The aim of this study is to evaluate this technique through an analysis of comparative studies in the current literature.Methods
We performed a comprehensive search of PubMed, MEDLINE, Cochrane, CINAHL, and EMBASE databases using various combinations of the keywords “Knee,” “Replacement,” “Prosthesis,” “Patella,” “Resurfacing,” and “Arthroplasty.” All articles relevant to the subject were retrieved, and their bibliographies were hand searched for further references relevant to primary patellar resurfacing in total knee arthroplasty. Only articles published in peer-reviewed journals were included in this systematic review.Results
The percentage for a reoperation was 1% for the patellar resurfacing group (17/1636) and 6.9% for the non-resurfacing group (118/1699) (odds ratio [OR] 0.18, 95% confidence interval [CI] 0.11-0.29, P < .00001). The patellar resurfacing group showed a significantly higher postop Knee Society Score (KSS) pain (OR 1.52, 95% CI 0.68-2.35, P = .004) and postop Hospital for Special Surgery score (OR 4.35, 95% CI 3.21-5.49, P < .00001), over the non-resurfacing group.Conclusion
Based on the outcome scores of KSS (pain), KSS (function), and Hospital for Special Surgery postop, patellar resurfacing TKAs have performed better than non-resurfaced TKAs. The lower secondary operation and revision rates for patellar resurfaced TKAs also demonstrate that this technique is the more effective option. However, the full impact of patellar resurfacing still needs to be critically evaluated by larger randomized controlled trials with long-term follow-up. 相似文献17.
Richard J. Hanly Salman K. Marvi Sarah L. Whitehouse Ross W. Crawford 《The Journal of arthroplasty》2017,32(9):2712-2716
Background
It is increasingly apparent that the effect of obesity in arthroplasty is joint-specific. This study evaluates the effects of morbid obesity on primary total knee arthroplasty by comparing short-term outcomes between a morbidly obese (body mass index ≥40 kg/m2) and a normal weight (body mass index 18.5-<25 kg/m2) cohort at our institution between January 2003 and December 2010.Methods
One hundred seventeen morbidly obese patients were compared with 94 normal weight patients. Operative time, length of stay, complications, 30-day readmission, and readmission length were compared.Results
Morbid obesity conveyed no significant increase in 30-day readmission. Operative time was increased at 100 minutes in the morbidly obese group, compared with 90.5 minutes (P = .026).Conclusion
Morbid obesity conveyed no increased risk of length of stay or readmission in this cohort. 相似文献18.
Masashi Uehara Jun Takahashi Yohei Akazawa Shugo Kuraishi Shota Ikegami Toshimasa Futatsugi Hiroki Oba Hiroyuki Kato 《Journal of orthopaedic science》2018,23(2):294-298
Background
As the surgical treatment of scoliosis after a Fontan procedure is very challenging due to the risk of various perioperative complications, case reports are scarce. We herein describe three patients who were successfully treated for scoliosis following a Fontan procedure and discuss their clinical and radiological outcomes.Methods
We retrospectively reviewed three cases of scoliosis treated by posterior spinal fusion after a Fontan procedure.Results
Mean preoperative major curve Cobb angle was 83.7°, mean surgical time was 233.0 min, and mean blood loss was 1167 g. The mean correction rate of the major curve was 48.0%. Surgical outcome as evaluated by Scoliosis Research Society-22 patient questionnaires revealed acceptable results without any severe complications.Conclusions
Corrective surgery for scoliosis after a Fontan procedure becomes a stronger option if cardiac insufficiency is prevented during the perioperative period and a conservative plan is carried out with minimal invasiveness and operation time. 相似文献19.
Dipak B. Ramkumar Niveditta Ramkumar Stephanie J. Tapp Wayne E. Moschetti 《The Journal of arthroplasty》2018,33(7):2092-2099.e9
Background
Total knee and hip arthroplasties can be associated with substantial blood loss, affecting morbidity and even mortality. Two pharmacological antifibrinolytics, ε-aminocaproic acid (EACA) and tranexamic acid (TXA) have been used to minimize perioperative blood loss, but both have associated morbidity. Given the added cost of these medications and the risks associated with then, a cost-effectiveness analysis was undertaken to ascertain the best strategy.Methods
A cost-effectiveness model was constructed using the payoffs of cost (in United States dollars) and effectiveness (quality-adjusted life expectancy, in days). The medical literature was used to ascertain various complications, their probabilities, utility values, and direct medical costs associated with various health states. A time horizon of 10 years and a willingness to pay threshold of $100,000 was used.Results
The total cost and effectiveness (quality-adjusted life expectancy, in days) was $459.77, $951.22, and $1174.87 and 3411.19, 3248.02, and 3342.69 for TXA, no pharmacologic hemostatic agent, and EACA, respectively. Because TXA is less expensive and more effective than the competing alternatives, it was the favored strategy. One-way sensitivity analyses for probability of transfusion and myocardial infarction for all 3 strategies revealed that TXA remains the dominant strategy across all clinically plausible values.Conclusion
TXA, when compared with no pharmacologic hemostatic agent and with EACA, is the most cost-effective strategy to minimize intraoperative blood loss in hip and knee total joint arthroplasties. These findings are robust to sensitivity analyses using clinically plausible probabilities. 相似文献20.